As a cardiologist, I often encounter confusion when patients are faced with the choice of treatment for coronary heart disease. Coronary heart disease, a term that sounds nerve-wracking, is actually one of the most common challenges in our daily work. In terms of treatment, bypass surgery and cardiac stent implantation are often the two options that are mentioned, and the choice of each method is closely related to the specific condition of the patient.
Today, I'd like to share a case I have worked on in the past, which is not only a story about technology choices, but also a story about shared decision-making between doctors and patients. A few years ago, I met a middle-aged male patient who was diagnosed with multiple blockages in blood vessels, and the situation was quite complicated. At first consultation, he had an anxious and uncertain look on his face, clearly bothered by the severity of the condition and the choice of treatment options.
After a detailed examination and evaluation, we found that he had severe stenosis in all three major coronary arteries, including the left main artery. Considering that he also has a background in diabetes, this further increases the complexity and risk of the surgery. After many exhaustive discussions with him and his family, we decided to go for coronary artery bypass grafting (CABG), the so-called "bypass" surgery. This decision took into account his overall condition, the expected long-term results, and his personal quality of life expectations.
Basic knowledge of coronary heart disease
Coronary heart disease, also known as coronary heart disease, is a common heart disease, which is mainly caused by the hardening of the coronary arteries supplying blood to the heart, resulting in narrowing or blockage of blood vessels, resulting in myocardial ischemia and hypoxia. If left untreated, this condition can lead to angina, myocardial infarction and even sudden cardiac death.
Primary Causes
The development of coronary heart disease is usually related to a variety of factors, including:
Lifestyle habits: Unhealthy eating habits (high fat, high cholesterol), lack of exercise, smoking, and excessive alcohol consumption all increase the risk of coronary heart disease.
Genetic factors: Individuals with a family history of coronary heart disease are at relatively high risk.
Age and sex: Increasing age is a natural factor in the increased incidence of coronary heart disease, with men showing symptoms of coronary heart disease earlier than women.
Chronic diseases: such as high blood pressure, diabetes, and high cholesterol are all risk factors for coronary heart disease.
Symptomatic presentation
The main symptoms of coronary heart disease include:
Angina pectoris: a sensation of pressure, pain or discomfort in the chest that often occurs during physical activity and lessens at rest.
Difficulty breathing: The heart is unable to pump blood effectively because of insufficient blood supply, resulting in shortness of breath during activity.
Fatigue: Patients may experience frequent fatigue due to decreased heart efficiency.
Palpitation: A rapid heartbeat may occur when the heart does not supply enough blood.
The difference between bypass surgery and stents
In the treatment of coronary heart disease, patients and doctors often have to choose between bypass surgery (coronary artery bypass grafting) and heart stents (percutaneous coronary intervention). Both approaches have their advantages and suitability, and understanding their key differences is critical to making the best treatment decisions.
Bypass Surgery (CABG)
Bypass surgery is a type of open chest surgery that bypasses a narrowed or blocked site on the heart by using blood vessels in the patient's body, usually veins in the legs or arteries in the chest wall. This procedure is particularly suitable for patients who:
Patients with multivessel disease: When multiple coronary arteries have severe disease, bypass surgery can address multiple problem areas at the same time.
Diabetic patients: For diabetic patients, bypass surgery has been shown to reduce mortality and the risk of major cardiac events more than stenting.
Severe monoarterial lesions, such as left main lesions, in which case bypass surgery is usually preferred.
Cardiac stent (PCI)
A heart stent is inserted through a small incision into an artery with an inflatable stent at the end to open the narrowed part of the blood vessel. Key benefits of stent implantation include:
Less trauma and faster recovery: Compared to thoracotomy, stent surgery is done through small incisions, and patients recover faster.
Suitable for single-vessel lesions: For patients with damage to only one blood vessel, stenting is a highly effective option.
Emergency: In the case of acute myocardial infarction, a stent can quickly open a blocked blood vessel and save the myocardium.
Compare the main advantages and limitations of both
While both methods are designed to improve the blood supply to the heart, they differ in their scenarios and long-term effects. Although bypass surgery is more invasive, it is more effective for long-term treatment of complex or multiple lesions, especially in patients with diabetes. Stent therapy, on the other hand, is more suitable for the treatment of lesions with a single or small number of blood vessels due to its minimally invasive and rapid recovery.
The final choice of treatment should be determined by a combination of the patient's specific condition, the doctor's recommendations, and the patient's personal preferences. Each approach has its own clear indications and potential risks, so it is important to have a thorough discussion with your cardiologist before making a decision.
When bypass surgery is preferred
When we talk about the treatment of coronary heart disease, especially between bypass surgery and heart stents, many patients and families are often confused. As a cardiovascular doctor, I often have this question in the outpatient clinic. Today, I am going to share the situations in which I would advise patients to prefer bypass surgery.
The extent of the lesion is extensive and complex
First, if the patient's coronary artery disease is extensive and structurally complex, such as multiple vessels being involved at the same time, bypass surgery is often a more appropriate option. Bypass can address multiple stenosis sites at the same time and restore blood flow to the heart muscle, whereas stents may need to be placed in multiple different locations, which is complex and relatively risky.
Polyvascular lesions or left main lesions
For those with multivessel disease or left main disease, bypass surgery is usually preferred. Left main disease is particularly dangerous because it affects the main artery that supplies blood to the heart and is extremely detrimental to heart function. In this case, bypass surgery can provide more stable and extensive blood flow to the heart, thus reducing the risk of myocardial infarction.
Special considerations for diabetics
Diabetic patients tend to have more complex vascular conditions than non-diabetic patients, and their small vessel disease changes are prevalent, which affects the success rate and long-term effectiveness of stent placement. Several studies have shown that bypass surgery provides better long-term outcomes for people with diabetes, especially those with more severe vascular lesions.
When making a decision about whether or not to undergo bypass surgery, we typically assess the patient's overall health, the type and extent of the lesion, and the expected improvement in quality of life. It's a holistic process that involves physicians, patients, and families in making decisions to ensure that the most appropriate treatment option for the patient is chosen.
The choice of bypass surgery is based on an accurate judgment of the condition and a long-term consideration of the future quality of life. Adequate communication with the physician to understand all the available treatment options is a necessary step for every patient when faced with this decision.